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Supplemental private insurance affects use of care and outcomes of Medicare patients who have heart attacks

Medicare patients who have supplemental private insurance and are hospitalized for heart attack are more likely than patients with Medicare only or Medicare and public insurance to undergo revascularization (bypass surgery or coronary angioplasty). They also are less likely to die in the hospital, according to a study by researchers from Albert Einstein College of Medicine that was supported in part by the Agency for Healthcare Research and Quality (HS11612).

Jing Fang, M.D., and Michael H. Alderman, M.D., used New York City hospitalization records to identify Medicare patients hospitalized for heart attack from 1988 through 2001. They compared rates of coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty (PTCA) and in-hospital mortality among patients with supplemental private insurance, those with Medicare insurance only, and those with dual Medicare and Medicaid coverage.

After accounting for other factors such as age and previous heart attack, patients with Medicare plus supplemental private insurance coverage were 69 percent more likely than those with Medicare only insurance to undergo PTCA and 53 percent more likely to undergo CABG. They were also 23 percent less likely to die in the hospital. Those with Medicare and Medicaid were 5 percent more likely than those with Medicare only insurance to undergo the two coronary procedures, and 5 percent less likely to die in the hospital.

Blacks and Hispanics with supplemental private insurance were 74 percent and 88 percent more likely, respectively, to undergo PTCA, and twice as likely to undergo CABG than blacks and Hispanics with Medicare coverage only. There were no differences between those with Medicare coverage only and those with Medicare and Medicaid. Blacks and Hispanics with supplemental private insurance were also 22 percent and 28 percent less likely, respectively, to die in the hospital than those with Medicare only.

See "Does supplemental private insurance affect care of Medicare recipients hospitalized for myocardial infarction?" by Drs. Fang and Alderman, in the May 2004 American Journal of Public Health 94(5), pp. 778-782.

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